Explore the vast range of titles available.

Hypertension, a leading global cause of death, poses challenges in stabilizing blood pressure within target values despite various therapeutic options, often necessitating multiple therapy adjustments and delayed impact assessments. Recently, the first wrist-based wearable blood pressure measurement devices were introduced which allow for a continuous assessment of blood pressure trajectories. This enables the development of statistical methodology for prediction of saturated steady-state of blood pressure under treatment—and thus allowing physicians to adjust the therapy earlier. As a prerequisite for the evaluation of such models and algorithms, it is necessary to simulate reliable and realistic hypothetical patient trajectories under treatment with antihypertensive medication. In this paper, we propose a simulation framework for blood pressure profiles through Pharmacokinetic-Pharmacodynamic modeling, which incorporates individual daily rhythms, patient characteristics, and medication effects. We also propose and evaluate two models for steady-state prediction under antihypertensive therapy, a Gaussian process and a non-linear mixed effect model. When only one day of measurements is available, the Gaussian process is preferred, but in real-world situations with more data, the non-linear mixed effect model is favored. It effectively reduces RMSE and bias in noisy data, outperforming the Gaussian process regardless of sample size.

Background Machine learning (ML) is increasingly used in research for subtype definition and risk prediction, particularly in cardiovascular diseases. No existing ML models are routinely used for cardiovascular disease management, and their phase of clinical utility is unknown, partly due to a lack of clear criteria. We evaluated ML for subtype definition and risk prediction in heart failure (HF), acute coronary syndromes (ACS) and atrial fibrillation (AF). Methods For ML studies of subtype definition and risk prediction, we conducted a systematic review in HF, ACS and AF, using PubMed, MEDLINE and Web of Science from January 2000 until December 2019. By adapting published criteria for diagnostic and prognostic studies, we developed a seven-domain, ML-specific checklist. Results Of 5918 studies identified, 97 were included. Across studies for subtype definition ( n  = 40) and risk prediction ( n  = 57), there was variation in data source, population size (median 606 and median 6769), clinical setting (outpatient, inpatient, different departments), number of covariates (median 19 and median 48) and ML methods. All studies were single disease, most were North American ( n  = 61/97) and only 14 studies combined definition and risk prediction. Subtype definition and risk prediction studies respectively had limitations in development (e.g. 15.0% and 78.9% of studies related to patient benefit; 15.0% and 15.8% had low patient selection bias), validation (12.5% and 5.3% externally validated) and impact (32.5% and 91.2% improved outcome prediction; no effectiveness or cost-effectiveness evaluations). Conclusions Studies of ML in HF, ACS and AF are limited by number and type of included covariates, ML methods, population size, country, clinical setting and focus on single diseases, not overlap or multimorbidity. Clinical utility and implementation rely on improvements in development, validation and impact, facilitated by simple checklists. We provide clear steps prior to safe implementation of machine learning in clinical practice for cardiovascular diseases and other disease areas.

Background Over the past decade an increase in usage of electronic health data (EHR) by office-based physicians and hospitals has been reported. However, these data types come with challenge regarding completeness and data quality and it is, especially for more complex models, unclear how these characteristics influence the performance. Methods In this paper, we focus on joint models which combines longitudinal modelling with survival modelling to incorporate all available information. The aim of this paper is to establish simulation-based guidelines for the necessary quality of longitudinal EHR data so that joint models perform better than cox models. We conducted an extensive simulation study by systematically and transparently varying different characteristics of data quality, e.g., measurement frequency, noise, and heterogeneity between patients. We apply the joint models and evaluate their performance relative to traditional Cox survival modelling techniques. Results Key findings suggest that biomarker changes before disease onset must be consistent within similar patient groups. With increasing noise and a higher measurement density, the joint model surpasses the traditional Cox regression model in terms of model performance. We illustrate the usefulness and limitations of the guidelines with two real-world examples, namely the influence of serum bilirubin on primary biliary liver cirrhosis and the influence of the estimated glomerular filtration rate on chronic kidney disease.

Cardiovascular ageing is a process that begins early in life and leads to a progressive change in structure and decline in function due to accumulated damage across diverse cell types, tissues and organs contributing to multi-morbidity. Damaging biophysical, metabolic and immunological factors exceed endogenous repair mechanisms resulting in a pro-fibrotic state, cellular senescence and end-organ damage, however the genetic architecture of cardiovascular ageing is not known. Here we use machine learning approaches to quantify cardiovascular age from image-derived traits of vascular function, cardiac motion and myocardial fibrosis, as well as conduction traits from electrocardiograms, in 39,559 participants of UK Biobank. Cardiovascular ageing is found to be significantly associated with common or rare variants in genes regulating sarcomere homeostasis, myocardial immunomodulation, and tissue responses to biophysical stress. Ageing is accelerated by cardiometabolic risk factors and we also identify prescribed medications that are potential modifiers of ageing. Through large-scale modelling of ageing across multiple traits our results reveal insights into the mechanisms driving premature cardiovascular ageing and reveal potential molecular targets to attenuate age-related processes. Cardiovascular ageing is characterised by a progressive decline in function, which contributes to multi-morbidity. Here, the authors use machine learning to predict biological age and identify key genetic risk factors.

Metabolite levels in urine may provide insights into genetic mechanisms shaping their related pathways. We therefore investigate the cumulative contribution of rare, exonic genetic variants on urine levels of 1487 metabolites and 53,714 metabolite ratios among 4864 GCKD study participants. Here we report the detection of 128 significant associations involving 30 unique genes, 16 of which are known to underlie inborn errors of metabolism. The 30 genes are strongly enriched for shared expression in liver and kidney (odds ratio = 65, p-FDR = 3e−7), with hepatocytes and proximal tubule cells as driving cell types. Use of UK Biobank whole-exome sequencing data links genes to diseases connected to the identified metabolites. In silico constraint-based modeling of gene knockouts in a virtual whole-body, organ-resolved metabolic human correctly predicts the observed direction of metabolite changes, highlighting the potential of linking population genetics to modeling. Our study implicates candidate variants and genes for inborn errors of metabolism. Metabolites are indicators of health and disease; genetic studies can reveal variants influencing their levels. Here, the authors investigate the contribution of rare, exonic variants on the levels of urine metabolites and generate predictions on metabolic consequences underlying metabolic disease.

Electronic health record (EHR) datasets are statistically powerful but are subject to ascertainment bias and missingness. Using the Mass General Brigham multi-institutional EHR, we approximated a community-based cohort by sampling patients receiving longitudinal primary care between 2001-2018 (Community Care Cohort Project [C3PO], n  = 520,868). We utilized natural language processing (NLP) to recover vital signs from unstructured notes. We assessed the validity of C3PO by deploying established risk models for myocardial infarction/stroke and atrial fibrillation. We then compared C3PO to Convenience Samples including all individuals from the same EHR with complete data, but without a longitudinal primary care requirement. NLP reduced the missingness of vital signs by 31%. NLP-recovered vital signs were highly correlated with values derived from structured fields (Pearson r range 0.95–0.99). Atrial fibrillation and myocardial infarction/stroke incidence were lower and risk models were better calibrated in C3PO as opposed to the Convenience Samples (calibration error range for myocardial infarction/stroke: 0.012–0.030 in C3PO vs. 0.028–0.046 in Convenience Samples; calibration error for atrial fibrillation 0.028 in C3PO vs. 0.036 in Convenience Samples). Sampling patients receiving regular primary care and using NLP to recover missing data may reduce bias and maximize generalizability of EHR research.

Diastole is the sequence of physiological events that occur in the heart during ventricular filling and principally depends on myocardial relaxation and chamber stiffness. Abnormal diastolic function is related to many cardiovascular disease processes and is predictive of health outcomes, but its genetic architecture is largely unknown. Here, we use machine-learning cardiac motion analysis to measure diastolic functional traits in 39,559 participants of the UK Biobank and perform a genome-wide association study. We identified nine significant, independent loci near genes that are associated with maintaining sarcomeric function under biomechanical stress and genes implicated in the development of cardiomyopathy. Age, sex and diabetes were independent predictors of diastolic function and we found a causal relationship between genetically determined ventricular stiffness and incident heart failure. Our results provide insights into the genetic and environmental factors influencing diastolic function that are relevant for identifying causal relationships and potential tractable targets.

Biosimilars are copies of biological medicines developed after the patent for the originator drug (the reference product) has expired. Extensive clinical trials are required to show the therapeutic equivalence of the biosimilar and its reference product before the biosimilar can be sold on the market. However, even after more than 10 years of experience with biosimilars, there is still uncertainty whether patients can switch between the biosimilar and its reference product without negative effects. One convenient way to assess the impact of switches is to analyze their mixed and self carryover effects: if the products are switchable, there should be no difference between the carryover effects. For p = 3 periods (and the number of subjects is divisible by 8) and for p ≡ 1 mod 4 periods (and the number of subjects is divisible by 4), determine a series of simple designs that efficiently compare the mixed and self carryover effects of two treatments. The proof of the efficiency is not straightforward, because the information matrices of the efficient designs are not completely symmetric.

The kidneys operate at the interface of plasma and urine by clearing molecular waste products while retaining valuable solutes. Genetic studies of paired plasma and urine metabolomes may identify underlying processes. We conducted genome-wide studies of 1,916 plasma and urine metabolites and detected 1,299 significant associations. Associations with 40% of implicated metabolites would have been missed by studying plasma alone. We detected urine-specific findings that provide information about metabolite reabsorption in the kidney, such as aquaporin (AQP)-7-mediated glycerol transport, and different metabolomic footprints of kidney-expressed proteins in plasma and urine that are consistent with their localization and function, including the transporters NaDC3 ( SLC13A3 ) and ASBT ( SLC10A2 ). Shared genetic determinants of 7,073 metabolite–disease combinations represent a resource to better understand metabolic diseases and revealed connections of dipeptidase 1 with circulating digestive enzymes and with hypertension. Extending genetic studies of the metabolome beyond plasma yields unique insights into processes at the interface of body compartments. Genome-wide studies of 1,916 plasma and urine metabolites from 5,023 participants of the German Chronic Kidney Disease study provide insights into systemic and kidney-specific enzymatic and transport processes.